Individual
HEATHER DANELLE BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
903 S 12TH ST, ROCKY FORD, CO 81067-2127
(719) 254-7623
Mailing address
903 S 12TH ST, ROCKY FORD, CO 81067-2127
(719) 254-7623
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
905876
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
905876
LICENSURE
CO
Enumeration date
03/01/2021
Last updated
03/01/2021
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